| NPI | 1477117190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 1191) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AZ POD-001084) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2025-03-18 |